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Transforming Health: PA's proposed Medicaid overhaul

(Harrisburg) -- After holding seven statewide hearings, conducting two webinars and collecting more than a month's worth of written public comments, the state Department of Public Welfare will soon submit its formal waiver application for a Medicaid overhaul in Pennsylvania.

The so-called Healthy PA plan would create a new private coverage option for an estimated 500,000 low-income Pennsylvanians, who are currently uninsured. It would also impose a series of changes to the state's existing Medicaid program.

About 40 people signed up to speak at the Harrisburg hearing, held recently at inside the State Museum of Pennsylvania's auditorium, and they first lodged complaints about Pennsylvania's unwillingness to expand Medicaid under the federal Affordable Care Act, as all six surrounding states have already done.

State Representative Gene DiGirolamo was among them. But the Bucks County Republican also appears ready to compromise, suggesting he could draw up legislation that allows Pennsylvania to expand Medicaid now, while still negotiating an alternative with the federal government.

"But I need an indication from the administration that they're on board with this," he says. "There's no sense in me moving a bill out of committee that's going to just sit there. My leadership is not going to bring it up unless they have a signal from the governor and the administration."

There's been no such signal yet, and Secretary Mackereth's comments suggest it may not be forthcoming.

"Without doing the reform first, I don't think financially we would be able to do it," she said in response to a question about DiGirolamo's statement. "We certainly can run the numbers. We're going to take a look at it. Again, we're taking public comment very serious."

Antoinette Kraus

Since last February's budget address, the Corbett administration has maintained a Medicaid expansion is not financially sustainable.

Mackereth says a combined $20 billion federal and state dollars is already spent on Pennsylvania's Medicaid program each year, and state spending for existing recipients is growing by $300 - $400 million annually.

Medicaid expansion supporters counter the expansion could inject up to $4 billion federal dollars a year into the state's economy, which means Pennsylvania is losing $10 million each day it waits.

They also question the administration's proposed changes to Medicaid, which include new benefits plans, a work search requirement for able-bodied adults and new monthly premiums based on income.

"I went with Governor Corbett, in February, to meet with [U.S. Department of Health and Human Services] Secretary [Kathleen] Sebelius and her team, and when we told them that we had 14 different benefit plans, they were shocked," she says.

"They were also concerned about the cost and the percent of our Pennsylvania budget that is consumed by Medicaid. So they have been working with us, this past year, to really look at what things we can do differently... and what makes sense."

Looking at the changes the administration wants to make, a number of exemptions are attached to its proposed work search requirement, including one for anybody working at least 20 hours a week in a part-time job. The DPW secretary says she recognizes Pennsylvanians want to work, and maintains the JobGateway will provide the tools to get them there.

Inside the seventh and final Healthy PA hearing

Speaker-after-speaker at the Harrisburg hearing decried the administration's planned premium structure for Medicaid recipients. But, Mackereth contends low monthly premiums make more sense than the existing co-pay structure they would replace.

"When people go from being well to being sick, just at the drop of a hat, the co-payments can add up and be much more than what we are proposing," she explains. "We are also proposing that there be incentives for people. So, if you get your physical exam, if you do your health screening, if you pay your premium on-time, immediately you'll get a reduction."

Anyone living at zero to 50 percent of the poverty level would be exempt from the premiums, which start at $13 per month for a single adult with income between 50 and 100 percent of poverty.

Critics still call it a barrier, and fear that -- unlike the existing co-pay structure -- a few missed payments would result in dropped coverage.

All public comments are being considered as the agency works to tweak the details of the plan ahead of its formal application. Buts its controversial tenets are expected to stay.

While the audience and the administration didn't always agree at these statewide hearings, Mackereth believes the public, the state and the federal government all want the same thing: to ensure health coverage for another 500 thousand Pennsylvanians.